| NPI | 1699731901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 24788) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 38051) |
| 208600000X Surgery (Licence: SD 5454) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-07-07 |